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How Does Testosterone Replacement Therapy (TRT) Affect Fertility?

Testosterone replacement therapy (TRT) can help men with low testosterone to have more energy, focus more easily, lose weight and build muscle, but what is the effect of TRT on fertility. There are some side effects that men considering this type of therapy need to take into account. In particular, men who want to have children in the future need to be aware of the possibility of TRT suppressing their fertility.

Naturally produced testosterone is important for male fertility, but other hormones also have essential roles to play. Although TRT can normalize testosterone levels, it does not improve fertility because it suppresses the pathway for managing the levels of the other hormones involved in testicular stimulation. In fact, TRT can even decrease sperm production and therefore negatively affect fertility.

TRT & Fertility

Male fertility is controlled by a part of the brain known as the hypothalamus and the pituitary gland. The hypothalamus produces a chemical called gonadotropin-releasing hormone (GnRH), which sends a message to the pituitary gland to tell it to produce two important fertility hormones, which are known as luteinizing hormone (LH) and follicular stimulating hormone (FSH). 

FSH is responsible for triggering spermatogenesis – the process of creating sperm cells. FSH causes cells in the testes to divide via meiosis to create sex cells, each containing only one half of a normal set of chromosomes. These cells mature into sperm cells, which can combine with a female egg to create a new human being with a full set of DNA. Meanwhile, LH causes the testes to produce testosterone and this too has a hand in promoting sperm production. 

While TRT increases testosterone levels, and reduces some of the symptoms associated with hypogonadism, it decreases the body’s production of LH and FSH. This is because when the brain detects that testosterone levels have increased, it will dial down the production of GnRH. The result is that the pituitary gland no longer produces FSH and LH at normal levels, so sperm production also declines. A lower sperm count means that a man’s chance of impregnating his partner will be lower.

This cannot be relied upon to render a man “infertile”, and should not be viewed as an alternative to contraception.


Preserving Fertility While Using Testosterone

For men who want to father children, the decision over whether or not to have testosterone replacement therapy is a difficult one. On the one hand, TRT can bring massive improvements to a man’s quality of life, by reducing fatigue, aiding concentration, and restoring his sex drive to its usual level. On the other hand, there is a risk that TRT will adversely affect fertility. 

One solution is to bank some sperm before starting TRT. Sperm can be stored at a sperm bank for many years and used to impregnate the man’s partner when the right time comes. Couples have successfully conceived children using sperm that has been frozen for up to 12 years, so this can be a good option for men who do not want children right now but want to keep the option open for the future.

Studies have shown that sperm count often returns to normal several months after stopping testosterone replacement therapy. However, for men who do not want to risk not being able to father a child, banking sperm before starting TRT makes sense. Another option is to delay TRT until a child has been conceived. This is not an option for everyone, but it can be a possibility for couples who are ready to consider starting a family.

A short-term option for some men would be the use of hCG (human chorionic gonadotropin) for TRT. The hormone hCG mimics LH in the body without suppressing the levels of GnRH or FSH and therefore may actually have a positive effect on fertility. While this is not the best way to maintain normal testosterone levels, it is something that we would be happy to discuss with you if maintaining fertility is a concern for you or your family.

Making the right decision for you and your family is of utmost importance. There aren’t a lot of guarantees, but reasonable measures can be taken to lessen the negative impact that exogenous testosterone and TRT has on fertility.

Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3635615/
http://www.spermbankdirectory.com/faqs/frozen-sperm-efficacy.htm

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(Augie) Juan Augustine Galindo Jr. MPAS, PA-C

(Augie) Juan Augustine Galindo Jr. MPAS, PA-C started his career in healthcare as a fireman/paramedic in West Texas where he served on the Midland Fire Department from 1998-2004.   He became interested in testosterone treatment after seeing how hormone replacement doctors helped those suffering from low testosterone.   After graduating from the Texas Tech Health Sciences Center Physician Assistant Program, he moved to DFW where he currently lives with his wife and three children.

48 Comments

  1. Brad Duda on 06/15/2015 at 6:35 pm

    I have been diagnosed with hypogonadism. The cause has not been determined as of yet. But I was told that what ever the cause I will most likely need to do TRT because my FSH (46+) & LH (12+) levels are very high and my free testosterone is in the low range between 1.4 to 3.5 but my total is in the normal range 325 to 540. I know your information said 15 would be the target for the free 500 to 1000 for the total. So if you increase the total what makes it end up free instead of bound? If you doubled the total that would be would make it between 650 and 1100, but the free would have to go by over 4 times to be in the ideal range. So if the free also only doubles it would still be low so what would you do in that case? Is there something that controls what gets bound and what stays free? Thanks Brad

    • Augie Galindo on 06/16/2015 at 8:21 am

      Thank you for the comment/questions, Brad. It is very common for the root cause of hypogonadism to be indeterminate. The target levels described in my videos are rough guidelines, and not hard boundaries. Also, keep in mind that “when” you test matters, and we typically manage TRT by measuring at the trough. Peaks would be much higher, but still in the normal range. Additionally, the relationship between total and free testosterone is not necessarily linear. The production of SHBG (a chief determining factor in how much free T is left) is a dynamic process that is often influenced by TRT. The goal is to never let your free T get below a certain threshold, but managing the logistics of landing there isn’t really a cookie cutter process. Each person’s lab results will look at least slightly different when they are optimized. I hope that helps, Brad. I will also reach out to you via email just in case you have any other questions I can help with.

  2. Augie Galindo on 06/20/2015 at 10:29 am

    Stacie,

    That is generally believed to be true, and has been seen time and time again in patient experience. However, there is no definitive study that identifies whether that is a safe assumption, 100% of the time.

    This is what I have seen in our practice, but understand that the use of testosterone still carries some inherent risk to fertility.

    • surya on 08/29/2015 at 11:39 pm

      I have some serious questions about testosterone…please help

      • Augie Galindo on 08/30/2015 at 1:13 am

        What questions do you have?

        • surya on 08/30/2015 at 1:16 am

          Urologist…I m 27 years .since one year I m struggling though lack of sexual desire and erectile dysfunction. But now it have gone worse ..now I have no desire for sex.. in August I got my total and free testosterone levels checked and both are in normal range.total testosterone levels are 512 pg/ml normal range 250-800 and free testosterone levels are 8.0 pg/ml normal range 4.0-30.. now I m really confused..please suggest what to do next? Should I use testosterone replacement? Being in normal range is it going to help me or will prove harmful? And once after going through this
          Therapy will my sexual desire get normalized or I will have to depend on this therapy for my life…and I have no medical history I m completely healthy no stress ,anxiety issues etc…plz answer

        • surya on 08/30/2015 at 1:19 am

          …I m 27 years .since one year I m struggling though lack of sexual desire and erectile dysfunction. But now it have gone worse ..now I have no desire for sex.. in August I got my total and free testosterone levels checked and both are in normal range.total testosterone levels are 512 pg/ml normal range 250-800 and free testosterone levels are 8.0 pg/ml normal range 4.0-30.. now I m really confused..please suggest what to do next? Should I use testosterone replacement? Being in normal range is it going to help me or will prove harmful? And once after going through this
          Therapy will my sexual desire get normalized or I will have to depend on this therapy for my life…and I have no medical history I m completely healthy no stress ,anxiety issues etc…plz answer

          • Augie Galindo on 08/30/2015 at 1:25 am

            Surya,

            It’s sounds as if you are frankly symptomatic. If your free testosterone level was measured by a direct analog assay, then it is not clinically useful. I would start by retesting your total testosterone and then also check your albumin and SHBG levels to give you the necessary data for calculation of your free testosterone.

            Check out my videos to better understand the issue, here: http://youtu.be/k7eu9RnZOvI

            Best regards,

            Augie Galindo, PA-C
            Testosterone Centers of Texas – Founding Partner



          • surya on 08/30/2015 at 1:44 am

            Thanks sir a lot…My levels were measured by C.L.I.A method..I don’t know what’s that exactly….is my free testosterone level really low ? If it’s in normal range than what’s main cause of my problem? what should be my next step now ? What are other tests to reach at the root of problem….



          • Augie Galindo on 08/30/2015 at 8:53 am

            The standard lab test for free testosterone is highly inaccurate and The Endocrine Society has declared that it should not be used clinically. A calculated free testosterone test will give you better accuracy. You may want to have someone look into your thyroid health as well.



          • surya on 08/30/2015 at 9:31 am

            Sir actually I am from India and here all labs use same methodology..I also tried another lab where my free testosterone levels were 7.something…when no other methodology or procedure is available here ..I am really confused how to get exact value of my free testosterone..please suggest…thanks ..



          • Augie Galindo on 08/30/2015 at 9:51 am

            This site: http://www.issam.ch/freetesto.htm utilizes the most widely used algorithm for calculating your free testosterone. The normal reference range is 9-30 ng/dl. You will need your total testosterone, SHBG, and albumin.



  3. surya on 08/30/2015 at 10:00 am

    Ok sir… my values are in pg/ml..I have not got tested my SHBG and Albumin…next time after test I will post my SHBG and Albumin levels along with free and total testosterone…as my values are in pg/ml ..if you can convert them in relevant levels to get my exact free testosterone levels I am ready to pay for that … I hope this help from you …thanks a lot …

  4. Tyson on 09/01/2015 at 11:20 am

    Hi…I was told by a weight loss clinic that I have low test level…432. I’ve been on 200mg a week for the last 10 weeks. My wife and I want to have a child, but I’ve been reading that I wouldn’t be able to…we are a little scared. Should I stop the trt and if so what can I do to help my guys get the job done?

    • Augie Galindo on 09/01/2015 at 12:25 pm

      Tyson,

      You will definitely want to consult a fertility specialist, however, testosterone is known to reduce fertility and it is unclear how long that suppression lasts. You can use human chorionic gonadotropin (hCG) to both improve testosterone levels while improving fertility. This is an off label use, but it is a very common practice amongst fertility providers. The amount of suppression present is often dose dependent, and a 200 mg per week dose is a bit on the high side. To know where you stand, you would need a thorough workup and semen analysis.

      Best regards,

      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  5. Joseh on 09/28/2015 at 6:04 am

    Hi,

    It took menegon and pregnyl for 6 months, before taking them my sperm count was zero, but after some sperms were able to be seen. Following we did an Ivf and now we are blessed with a baby boy. Since then my testosterone was dropped dramatically as I am not taking any medications. Now since we are planning for another baby after 12 months , shall I take testosterone shots to restore sex drive and then get back to hcg shots for the second baby or I shall not take any testosterone shots at all?

    • Augie Galindo on 10/02/2015 at 11:16 pm

      Joseh,

      If you are contemplating having another child in the near future, definitely don’t start testosterone now. Find a provider who will work with you and perhaps prescribe hCG monotherapy to improve your testosterone levels while hopefully boosting your fertility.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  6. fernando on 11/05/2015 at 8:15 pm

    I have a question 2 months ago I went in for some blood tests and my free testosterone came back low my over all testosterone was a slight low but only by 2points so I went back last week for a re tests and my free testosterone went up but my over all test went down and I don’t have any symptoms at all my libido is thru the roof my strength in the gym is rising I can feel and see my muscle mass getting bigger oh and also my kidneys liver and thyroid is fine what could be the problem?

    • Augie Galindo on 11/10/2015 at 7:43 am

      Fernando,

      Ultimately, TRT is about improving quality of life through treating symptoms. So, since you don’t seem to be suffering with any symptomatic change, I wouldn’t recommend therapy, regardless of you lab tests.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

  7. Jc on 12/04/2015 at 12:39 am

    I am 35 and have very low testosterone levels my concern is that my voice is very at a very high pitch level like a womans and I haven’t any facial hair, my question is what kind of treatment is best for me to look and sound a little more “normal”? This has haunted me all my life and I know there are treatmenta out there I just need some guidance thank you in advance

    • Augie Galindo on 12/05/2015 at 12:13 pm

      Jc,

      The form of therapy I most often recommend is medically supervised TRT, via injections. Do a careful inventory of symptoms, familiarize yourself with the potential side effects/risks of therapy, and find a knowledgeable clinician near you to help select what method is best for you.

      Best regards,
      Augie Galindo, PA-C
      Testosterone Centers of Texas – Founding Partner

    • legnagelan on 12/29/2015 at 2:09 am

      I started it one month ago because of the same and I haven’t had any positive result so far more than oily face and scalp.

      • Augie Galindo on 12/30/2015 at 8:35 am

        Make sure dosing, frequency, consistency, and management of side effects are in check. Once all that is settled, it is still fairly common to not see significant change until the second month of therapy.

        Best regards,
        Augie Galindo, MPAS, PA-C
        Testosterone Centers of Texas – Founding Partner

  8. […] How Does TRT Affect Fertility – Testosterone Centers of Texas – Testosterone replacement therapy (TRT) can help men with low testosterone to have more energy, focus more easily, lose weight and build muscle, but what is the effect … […]

  9. Jake on 12/28/2015 at 5:01 pm

    I was on TRT for a few years (300mg/2weeks) and made me feel great and I truly appreciated the benefits. I am 31, tested at 171 and 240 test levels.
    The issue is, my wife and I have been trying to conceive for 18 months to find out I have become sterile. (6,000 sperm count, 20% mobility) .
    Urologist suggested stopping TRT for 90 days to see what happens. I did, am now fertile in all ways (36 million sperm count, 70% mobility). However, I feel like absolute death. No libido, no energy, constant brain fog, borderline violent mood swings and irritability. I work out 5 days/week and have no weight loss or strength gains either.

    What can be done to help me, but maintain my fertility?

    Thank you very much.

    • Augie Galindo on 12/30/2015 at 8:33 am

      Jake,

      This fix is actually fairly simple, but you want to make sure it is managed appropriately. Ask your urologist about using hCG (human chorionic gonadotropin) monotherapy, while you and your wife are trying to conceive. If dosed correctly, you can improve testosterone levels, maintain fertility, and feel better through the process. It is not a long-term answer to TRT, but should work well in your case. Side effects will present, and estrogen production when hCG is used is typically higher than what you see with traditional TRT without hCG. If your urologist is uncomfortable with this type of therapy, you may want to seek out fertility specialist. They are likely to be very familiar with this use of hCG.

      Best regards,
      Augie Galindo, MPAS, PA-C
      Testosterone Centers of Texas – Founding Partner

  10. Brittany on 04/18/2016 at 12:41 pm

    My husband has been on TRT for about 1.5 years. We are going to try to conceive ASAP. Can he start taking HCG along with his testosterone shots to increase fertility or do you recommend him completely quitting the trt (something he does not want to do)?

    • Augie Galindo on 04/19/2016 at 11:27 pm

      Brittany,

      I typically do recommend that my patients who are serious about trying to conceive immediately stop testosterone and switch to hCG monotherapy. You have to manage this appropriately, but you can still attain higher than baseline T levels without the suppression of fertility. It is not optimal for testosterone, but it is better for fertility. Now, that being said, my wife I had our third child while I was on testosterone with hCG. There are scores of anecdotal (not just my personal experience) reports of couples successfully achieving pregnancy while using hCG concurrently with testosterone.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  11. Kyle on 06/27/2016 at 11:18 am

    My wife and I are currently trying to conceive and have been using a fertility specialist for several months the now. I have been on TRT for a year or more now but also taking hcg weekly with the testosterone. My testosterone levels were at 67 before I started and now are in the 500’s. My question is this; should I stop taking testosterone during these fertility treatments even though my sperm count was around 20 million at the last IUI? I am afraid if I stop the testosterone, my levels will once again plummet so low that surely my sperm count would be affected. I mean, at 67 on my total testosterone levels, I didn’t even want to get out of bed. Are the hcg shots helping keep my sperm levels up? Could I also take something like Nolvadex on a weekly basis to help?

    • Augie Galindo on 07/12/2016 at 10:19 pm

      Kyle,

      This is a complicated issue. Without a doubt, the use of testosterone (regardless of adjunct therapy) has, at the very least, the potential to reduce fertility. The factor by which this happens is unknown. While it remains possible that testosterone could eliminate fertility altogether, that is highly unlikely and it’s not what I have seen clinically. The use of hCG can help to improve fertility even with TRT, but again, by what factor is unknown. Monotherapy with hCG is the safest way to proceed when concerned about fertility. It’s not the only way, but the safest. You will need to find a provider well versed in this, and don’t be surprised if your best bet is a fertility specialist. After conception, or if you are willing to accept other risks, then TRT with testosterone plus hCG is an option. And, yes, a very low naturally produced testosterone “could” have a negative impact on fertility.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  12. Travis on 06/29/2016 at 10:16 am

    I started TRT in May 2016, 1ml every two weeks. I have had two doses and will administer my third this Friday 7/1/16. My question is, regarding fertility, how soon after starting TRT do you normally see a drop in sperm count and fertility? My wife and I want to have another child, but we are not ready just yet. Is it too late to bank sperm?

    • Augie Galindo on 07/12/2016 at 10:46 pm

      Travis,

      The best answer I can give is, maybe. There are other ways to partially protect fertility, but you may need to explore other options if your desire to have a child is imminent. Also, I strongly recommend that you revisit with your provider the decision to utilize 14 day intervals. The options to explore include hCG monotherapy, testosterone with hCG, or sperm banking.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  13. Gabby on 08/24/2016 at 9:32 pm

    I have a question….my fiancé has been taking testosterone for some years now and hasn’t been able to father any children, well he stopped taking it for several months…maybe 3 or 4…and just went back on it, now i haven’t gotten my period in 2 weeks and think i might be pregnant, could it be as a result of starting T again??

    • Augie Galindo on 08/25/2016 at 8:51 am

      Gabby,

      What I can tell you is that there is definitive, but not complete, suppression of fertility in patients taking testosterone. Once that therapy is withdrawn, the body usually makes an effort to rebound to baseline testosterone production and fertility. So, it is plausible that within the 3 to 4 months of being off testosterone, fertility was restored and pregnancy could then be achieved naturally and without any other intervention. Restarting testosterone would have had the same fertility suppressing effect I described before.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  14. Alex on 09/07/2016 at 8:17 am

    Hello,
    My husband has been taking testosterone injections which I’m aware decreases sperm count however on the chance that we do fall pregnant, are his sperm damaged or affected by the testosterone or are they completely normal?
    Thanks

    • Augie Galindo on 09/20/2016 at 11:36 pm

      Alex,

      There is no evidence that suggest that. I can tell you the many of my patients, and I myself have had perfectly healthy children while on TRT.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  15. John on 09/08/2016 at 5:28 pm

    I have a very low testosterone, my levels are around 224. I’m 31 years old and I’m pretty sure I’ve never had a normal testosterone level because I’ve had the symptoms from all the way back when I was a teenager until now. The symptoms were always misdiagnosed as depression and no doctor did blood tests until recently which showed me having low T and they said I’m the perfect candidate to start TRT except that my wife and I are planning on starting a family in probably about 2 years and my fertility is normal now so because of that they don’t want to start TRT. My doctor called today and said one option is to start a trial TRT run with injections and checking fertility as we go. My quality of life is is very low so this is a very tough decision. I also live in the Virgin Islands and they don’t bank sperm anywhere in the territory. Do you have any recommendations or advice?

    • Augie Galindo on 09/20/2016 at 11:51 pm

      John,

      Make sure you ask about using hCG (human chorionic gonadotropin) with TRT. You can do hCG monotherapy as well. These are other options that I prefer over T alone when wanting to preserve fertility.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

      • John on 09/21/2016 at 12:06 am

        Thank you Augie! I was planning on asking for hCG in conjunction with the TRT. I guess both my wife and I are very concerned about not getting fertility back if it does diminish while on TRT. My quality of life right now is absolutely horrible. We’re living in paradise in the Caribbean and I can’t even enjoy it cause I’m just stuck inside very tired and unmotivated 24/7. But we can’t start to try to have kids for another year and a half due to my wife being in school. I guess the advise I’m looking for is is it likely for fertility to came back if lost? I know you can never say for sure but the way my doctor is talking about it makes it seem like I will probably become infertile and the chances of it coming back are low. But that contradicts everything I’m reading so my wife and I just want some clarity and maybe some advice on, in your opinion, should I start the TRT with hCG or not and just wait until we’re done having kids (which I really don’t want to do because we want somewhere around 3 kids so if I wait we’re talking about quite a few years that I’ll be living with this terrible quality of life).

  16. RAY on 10/06/2016 at 3:41 am

    Hi am 25.. I was recently diagnosed of low T and olegospermia. I have a very poor sex drive and weak erection, the urologist suggest I try TRT but am scared I might not be able to father a child in future. Can TRT treat olegospermia? Am so confused.

    • Augie Galindo on 10/06/2016 at 11:04 am

      Ray,

      No, it cannot. That being said, there are ways to mitigate at least some of the threat to fertility while on TRT. I would strongly recommend that you have a direct conversation about fertility BEFORE you start therapy. There is an undoubted suppression of fertility with the use of testosterone, so knowing the risks and how to manage it is extremely important.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  17. Chandler on 12/01/2016 at 9:14 am

    Augie,

    First off, this has been the most beneficial info I have came across on the issue of TRT and fertility.

    My question is, I have been on TRT for a year and the time has come to have another child.. I was going to follow the protocol of quiting TRT and use clomid to help me kick start my HPTA. Is this a smart option or should i use HCG? – I ask because clomid is not mentioned here but is on other forums.

    Thanks in advance

    • Augie Galindo on 12/03/2016 at 7:06 pm

      Chandler,

      Thank you very much for the positive feedback!

      Great question! Clomid is often enlisted for this purpose, and for the sake completeness I am not a fertility specialist, but I prefer hCG still. Clomid works by fooling the hypothalamus into thinking that rising estradiol levels aren’t really there. That doesn’t safeguard the rest of your body from the effects of hyperestrogenism, nor does it keep SHBG levels from rising because of it and thereby reducing your free testosterone. Ultimately, Clomid will raise, LH, FSH, testosterone, sperm…and estrogen & SHBG levels. Not to mention its risk of visual impairment.

      The literature is relatively silent on these matters, but I personally prefer hCG. I have seen it work in my patients, and for myself. My 18 month old daughter was conceived while I was on testosterone and hCG concurrently, and many of the aforementioned have success story after success story with the same approach.

      This, however, is not without risk. This is very much a “family decision”. Monotherapy with hCG only is also an option, and still one that I find preferable to Clomid.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

  18. MG on 06/13/2017 at 7:19 am

    Hi Doc. Thank you for trying to help everyone. Clearly you are a kind hearted person.
    Quick question, I have low T and low sperm count but still 21 million sperms per total ejaculated 3ml. Being recommended to start TRT. I wanted to understand whether erections are still possible post complete testicular failure if one is on TRT? And secondly if testicular function stays as is at 21 million sperm count per total ejaculate and I start TRT, once TRT is stopped from your experience does sperm count tend to come back to the same as before TRT or is it unlikely to return to the same. I know you can’t give a certain answer but want to know what you think from your experience please. Also I have a grade 3 varicocele. The endocrinologist thinks this cannot be the root cause and wants me to start trt , do you think I should first eliminate the varicocele being the cause? My fsh and LH are 60% above normal range but not through the roof. Testosterone is on lower end of range but still in range but sperm count is a third below lowest range. I have a varicocele and smoked tons of weed. Been 15 days since I quit.
    Many thanks

    • Augie Galindo on 06/24/2017 at 7:34 pm

      MG,

      Thank you kindly for the feedback!

      We don’t routinely monitor sperm analyses for our patients, but to answer the question in another way, I have not seen any evidence that testicular function would fail to return to baseline after a transitional period following the cessation of TRT. Now, if the time that you are on testosterone is a number of years as opposed to a number of months, your underlying baseline changes will still have an effect on the “rebound”. If testicular function has been compromised by a varicocele, I think it would be unlikely that surgical fixation would return testosterone production to normal.

      Your hypothalamic and pituitary complex are already doing what they can to increase production, but based on this information it appears that you are in poor compensated hypergonadotrophic hypogonadism.

      Best regards,
      Augie Galindo MPAS, PA-C
      Testosterone Centers of Texas | Founding Partner

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